MARY VUONG, Copyright 2005 Houston Chronicle |
July 5, 2005

She gets only a grimace from the pint-size patient. Ezequiel, after realizing the day holds more than expected, has just punched his mother.

He is here to have his tonsils and adenoids removed, only Mom hasn't told him. It's clear to Tietjens that she's starting from scratch. After 15 years as a child-life specialist at Texas Children's Hospital, though, she knows exactly what to say next.

"Do you want to see the playroom?"

The playroom is filled with toys, including Big Wheels and other plastic rides that young patients get to cycle down the "see-you-later spot," the hallway where they part with their parents for the operating table.

"I always crash," Tietjens tells Ezequiel.

Her silliness prompts Ezequiel to crack a smile. Tietjens, no doubt, would fit right in on a public television children's show. Her work setting, with its colorful walls and child-friendly staff, is much warmer than other hospitals.

Ezequiel slips his right hand in a pocket, lets Mom hold the other. They tour the see-you-later spot, where Tietjens urges him to push a button on the wall.

"Ta dah!" she exclaims as double doors open.

"Look at them. They still have on their jammies," she says, motioning at staffers dressed in scrubs. One waves back.

Tietjens, 40, has a magic touch. She could give doctors a lesson in bedside manner — in her sleep. She's one of 27 child-life specialists at Texas Children's Hospital, charged with ensuring young patients are comfortable and understand the medical procedures they will undergo.

Most child-life programs started in the 1970s, Hollon says. In 23 years, the council has grown from about 200 members to 2,800, she adds.

Some specialists major in child life in college whereas others focus on topics such as child development and family studies. They must complete an internship before becoming specialists, and their duties may be supported by child-life partners/assistants.

Child-life specialists are always ready to share a smile and lend an ear. They want to make everything better for their charges. They befriend their patients, relay what to expect from their medical visit, teach them to cope and relax, serve as a sounding board and seek answers for their questions.

"The kids are so anxious, and the parents are so anxious," Tietjens says.

Ezequiel's mom, Natalie Ochoa, was nervous. "I was scared because I was by myself," Ochoa explains later. Her husband wasn't able to come that day, and she didn't understand the surgery procedure.

Tietjens, she says, wound up calming both her son and herself.

Working with children means Tietjens must be able to adapt at a moment's notice. When she meets Pablo Lopez Jr., the 3-year-old is so resistant to touring the hospital wing that his mother has to drag him along and his dad must block his escape route; Pablo just wants to return to the waiting room with the cool fish.

So Tietjens shortens the tour and abandons the room set aside for child-life conversations. They settle beside the big tank of fish instead.

Tietjens, in pale-blue scrubs, opens a plastic box that she carries and describes to Pablo and his parents what to expect in the operating room, such as the mask the anesthesiologist will put over his face and the different flavors he can choose from to disguise the medicinal smell. Cherry, bubble gum, banana and more.

To Pablo's parents, Tietjens also explains that an anxiolytic, a drug that can relieve their son's anxiety before his tonsillectomy and adenoidectomy, is available.

Young children sometimes won't let Tietjens demonstrate on them how the mask, EKG pads and pulse oximeter work, so she'll turn to Mom, Dad or herself. They want to know if they'll wake up from surgery or if someone will jump on their chests, like they do on ER.

Teenage and young-adult patients struggle with different issues. They lose the independence they gained being away at college, for one, and must rely on family and hospital staff, says Sarah Burkett, one of four child-life specialists at M.D. Anderson Cancer Center.

Burkett, 25, began working with patients not much younger than herself earlier this year.

She stops by Kimberly Gutierrez's room to invite her to Teen Grille. But the 13-year-old from the Rio Grande Valley doesn't feel like it.

"How 'bout if I told you it was tacos and chocolate chip cookies?" Burkett asks.

Teen Grille is a Thursday night event that brings her patients together to socialize and compare notes.

Some are too sick to join. Jonathan Bouchard, an 18-year-old from Alabama, has been through four rounds of chemo for his lung cancer. He's been at M.D. Anderson since Feb. 9.

When she drops by his room, Burkett promises to deliver cookies later. "We'll bring them fresh to you. I know you have a sweet tooth."

At which point Jonathan launches into a spiel about the benefits of eating sweets during chemo. "Jolly Rancher gummies make it more bearable," he says.

Burkett smiles.

To cope with the difficulties of working with sick children, Burkett relies on faith, family, colleagues and laughter for comfort. Tietjens, too.

Both women stress the importance of forging bonds with the patients and their families. Burkett plays detective to learn their likes and dislikes.

Tietjens reaps the rewards of her work with each patient. "By the time I finish their preparation, I can see what a difference it made," Tietjens says. "For me, it's like a direct feedback or reward. I've always loved working with kids, and I knew that I wanted to do something different than the more common jobs."